<div id="assignee_form_<?php echo $num ?>">
  <input type="hidden" id="application_corporate_managed_assignees_<?php echo $num ?>_id"
			 name="application_corporate_managed[assignees][<?php echo $num ?>][id]"
			 value="<?php echo $assignee->getId() ?>" />

  <h4>Assignee <?php echo $num+1 ?></h4>
  <dl class="sections">
    <dt>
      <label>Delete this Assignee</label>
    </dt>
    <dd>
      <input type="checkbox" value="Yes" name="application_corporate_managed[assignees][<?php echo $num ?>][delete]" />
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Name</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_name"
                        name="application_corporate_managed[assignees][<?php echo $num ?>][name]"
                        value="<?php echo $assignee->getName() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Subscription</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_subscription"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][subscription]"
                         value="<?php echo $assignee->getSubscription() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Addon Service 1</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_addon_service1"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][addon_service1]"
                         value="<?php echo $assignee->getAddonService1() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Addon Service 2</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_addon_service2"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][addon_service2]"
                         value="<?php echo $assignee->getAddonService2() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Addon Service 3</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_addon_service3"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][addon_service3]"
                         value="<?php echo $assignee->getAddonService3() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Addon Service 4</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_addon_service4"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][addon_service4]"
                         value="<?php echo $assignee->getAddonService4() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Addon Service 5</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_addon_service5"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][addon_service5]"
                         value="<?php echo $assignee->getAddonService5() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Device Model</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_device_model"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][device_model]"
                         value="<?php echo $assignee->getDeviceModel() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Device Base Price</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_device_base_price"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][device_base_price]"
                         value="<?php echo $assignee->getDeviceBasePrice() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Device Payment Scheme</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_device_payment_scheme"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][device_payment_scheme]"
                         value="<?php echo $assignee->getDevicePaymentScheme() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Total MSF</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_total_msf"
                         name="application_corporate_managed[assignees][<?php echo $num ?>][total_msf]"
                         value="<?php echo $assignee->getTotalMsf() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>IDD</label>
    </dt>
    <dd>
      <input type="checkbox" id="application_corporate_managed_assignees_<?php echo $num ?>_idd"
             checked="checked"
             name="application_corporate_managed[assignees][<?php echo $num ?>][idd]">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>International Roaming</label>
    </dt>
    <dd>
      <input type="checkbox" id="application_corporate_managed_assignees_<?php echo $num ?>_international_roaming"
             checked="checked" name="application_corporate_managed[assignees][<?php echo $num ?>][international_roaming]">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>GPRS Mobile Data</label>
    </dt>
    <dd>
      <input type="checkbox" id="application_corporate_managed_assignees_<?php echo $num ?>_gprs_mobile_data"
             checked="checked" name="application_corporate_managed[assignees][<?php echo $num ?>][gprs_mobile_data]">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Services others</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_services_others"
             name="application_corporate_managed[assignees][<?php echo $num ?>][services_others]"
             value="<?php echo $assignee->getServicesOthers() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Renewal Account Number</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_renewal_account_number"
             name="application_corporate_managed[assignees][<?php echo $num ?>][renewal_account_number]"
             value="<?php echo $assignee->getRenewalAccountNumber() ?>">
    </dd>
  </dl>
  <dl class="sections">
    <dt>
      <label>Renewal Mobile Number</label>
    </dt>
    <dd>
      <input type="text" id="application_corporate_managed_assignees_<?php echo $num ?>_renewal_mobile_number"
             name="application_corporate_managed[assignees][<?php echo $num ?>][renewal_mobile_number]"
             value="<?php echo $assignee->getRenewalMobileNumber() ?>">
    </dd>
  </dl>

</div>
<hr />